Psychopharm Flashcards
When is Psychological treatment first line
Anxiety, OCD , mild-moderate depression
Examples of Typical Antipsychotics
- Chlorpromazine
- Haloperidol
- Sulpride
- Zuclopenthixol (clopixol)
- Fluphenazine
Examples of Atypical Antipsychotics
• Lurasidone • Olanzapine • Quetiapine • Risperidone • Aripiprazole • Amisulpride -Clozapine
What is psychosis
Disorder of excess dopamine
What type of drugs are Antipsychotics
Dopamine Antagonists at D2 receptors
Do Antipsychotics affect negative symptoms
No
What are the Dopamine Pathways Relevant to Schizophrenia Syndromes
Positive - overactivity of mesolimbic pathway
Negative & cognitive - Dysfunction of mesocortical pathway
Adverse Affects of Antipsychotics
Mediated by dopamine antagonism
1- Nigrostriatal tract - Extra pyramidal side effects (EPSE) : Acute dystonia , Akathisia, tardive Dyskinesia, Parkinosonism
2- Tuberoinfundibular system –prolactin elevation
Mediated by other receptors • Serotonin • Histamine • Muscarinic • Alpha adrenergic
Which side effects are more common with 2nd generation Antipsychotics , which drugs specifically
Metabolic Effects
• Weight gain
• Dyslipidaemia
• Type 2 diabetes
Specifically: Quetiapine, olanzapine and clozapine
Antidepressants Types
SSRIs : Selective serotonin reuptake inhibitors
SNRIs : serotonin and noradrenaline reuptake inhibitors
NASSAs : noradrenergic and specific serotinergic
MAQIs : monoamine oxidase inhibitors
TCAs: tricyclic antidepressants
SSRIs MOA
Block serotonin transport in synapse , blocking the reuptake of serotonin into neurons = increase serotonin activity
What causes Depression
Functional deficiency of monoamines ( serotonin and noradrenaline ) : research not verified
How do antidepressants work
- Increase BDNF and stimulate neurogenesis = enhancing synaptic plasticity
- moderates limbic system to reduce cognitive bias
- increase serotinergic neurotransmission to modulate other neurotransmitter systems ( GABA , dopamine )
MOST effective with psychological and social interventions
What are Anxiolytics
Anxiety medications ; Benzodiazepines and GABA receptors
What is GABA-A receptor
important target for benzodiazepine and Z drugs
How do Benzodiazepines work
Increase affinity for GABA
- binding site is between alpha and gamma subunits
- different subunits will have different affects
Uses of benzodiazepine
- Anxiolytic
- Hypnotic
- Muscle relaxant
- Anti-convulsant
- Amnestic
Benzodiazepine affect on subunits a1 to a6
- α2 and 3: anxiolytic
- α1 and 5: sedation, amnesia and ataxia
- α1-6: anticonvulsant
Side Effects of Benzodiazepines
- Headaches
- Confusion, amnesia
- Ataxia
- Dysarthria
- Blurred vision
- Paradoxical (disinhibition) reaction
- At risk: children, LD, CNS disorder, impulsivity
- Interaction with alcohol at GABA receptor
- Overdose –rarely fatal alone but dangerous in combination with alcohol
Where does alcohol interact
GABA receptor
List drugs that act on GABA other than benzodiazepines
- Z drugs
- Barbituates
- Flumazenil
- Alcohol
What are Z drugs
Ex: Zolpidem, zopiclone
- Bind to benzodiazepine site at GABA-A receptor
- Short onset of action
- Specific to α-1 subtype –Hypnotic
- Anticonvulsant and muscle relaxant only at high doses
- Same Side effects as benzodiazepines
What are barbiturates
Ex: Amobarbital, phenobarbital, thiopentone
- used only for severe insomnia, epilepsy, induction of
anaesthesia
- Highly addictive, dangerous in overdose
What is Flumazenil
Competitive antagonist in benzodiazepine binding site
- Displaces Benzodiazepine
- Rapid onset of action but short half life
- shouldn’t be used if benzodiazepine is being used to treat epilepsy
What can be used to treat benzodiazepines OD
Flumazenil
Where is Alcohol an antagonist
At Glutamate receptors
Why do barbituates have a higher risk of toxicity
Benzodiazepines : increase affinity of GABA = increase frequency of opening of chloride channels , can only act if GABA present
Barbituates : increase duration chloride channels opening and can act in absence of GABA if at high doses = higher risk of OD
